Association of nonmelanoma skin cancer and actinic keratosis with cumulative solar ultraviolet exposure in Maryland watermen

Authors

  • Benjamin C. Vitasa MD, PhD,

    1. Departments of Environmental Health Sciences, The Johns Hopkins School of Hygiene and Public Health, Baltimore
    Current affiliation:
    1. Department of Environmental and Occupational Health, University of the Philippines, College of Public Health, 625 Pedro Gil Street, Manila, Philippines
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  • Hugh R. Taylor MD,

    Corresponding author
    1. Dana Center for Preventive Ophthalmology, The Wilmer Institute and the School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland
    • The Wilmer Institute, 600 North Wolfe Street, Baltimore, MD. 21205
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  • Paul T. Strickland PhD,

    1. Departments of Environmental Health Sciences, The Johns Hopkins School of Hygiene and Public Health, Baltimore
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  • Frank S. Rosenthal PhD,

    1. Departments of Environmental Health Sciences, The Johns Hopkins School of Hygiene and Public Health, Baltimore
    Current affiliation:
    1. National Occupational Health and Safety Commission, G.P.O. Box 58, Sydney, NSW 2001, Australia
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  • Sheila West PhD,

    1. Dana Center for Preventive Ophthalmology, The Wilmer Institute and the School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland
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  • Helen Abbey PhD,

    1. Departments ofBiostatistics, The Johns Hopkins School of Hygiene and Public Health, Baltimore
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  • See Ket Ng MD,

    1. Departments of Environmental Health Sciences, The Johns Hopkins School of Hygiene and Public Health, Baltimore
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  • Beatriz Munoz MS,

    1. Dana Center for Preventive Ophthalmology, The Wilmer Institute and the School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland
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  • Edward A. Emmett MB, MS

    1. Departments of Environmental Health Sciences, The Johns Hopkins School of Hygiene and Public Health, Baltimore
    Current affiliation:
    1. Departments of Family and Community Medicine and Pharmacology, University of Massachusetts Medical School, Worcester, MA 01605
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Abstract

To establish the relationship between ultraviolet-B radiation and squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and actinic keratosis (AK), a cross-sectional prevalence survey was performed in a sample of 808 white, male watermen 30 years of age and older residing in the Eastern Shore of Maryland. A measure of personal cumulative ultraviolet-B exposure was determined for each subject from data collected through interviews and field and laboratory measurements. A personal interview elicited skin type, medication history, and other factors. Clinical diagnoses and histologic confirmation were done for current and previously removed skin tumors. The ratio of subjects with SCC to subjects with BCC was approximately 1:1; however, the ratio of BCC to SCC was 1.25:1 because BCC cases were more prone to multiple lesions. Watermen with SCC or AK but not BCC had higher average annual ultraviolet-B doses than age-matched controls. This was particularly marked in watermen younger than 60 years of age. Logistic regression showed that an older age, childhood freckling, and blue eyes significantly increased the risk of the development of all three types of skin tumor. Ease of sunburning was associated with BCC and AK, but not with SCC. Watermen in the upper quartile of cumulative ultraviolet-B exposure had a 2.5 times higher risk for the development of SCC when compared with the lower 3 quartiles. This suggests that high levels of ultraviolet-B exposure are important in SCC occurrence. The risk of AK developing was 1.5 times higher for those whose cumulative ultraviolet-B exposure exceeded the median. The relationship of BCC to cumulative ultraviolet-B exposure was not clear and this suggests that different etiologic mechanisms operate for SCC and BCC.

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